Abstract
Background
Postnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition–adaptation, we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant patent ductus arteriosus (hPDA) by applying a pump model.
Methods
Pumping was characterized by EA (effective arterial elastance, reflecting afterload), EES (end-systolic LV elastance, reflecting contractility), EA/EES coupling ratios, descriptive EA:EES relations, and EA/EES graphs. Data calculated from echocardiography and blood pressure were analyzed by diagnosis (S group: clinically stable, no hPDA, n=122; hPDA group, n=53) and by periods (early transition: days of life 1–3; late transition: 4–7; and adaptation: 8–30).
Results
S group: LV pumping was characterized by an increased EA/EES coupling ratio of 0.65 secondary to low EES in early transition, a tandem rise of both EA and EES in late transition, and an EA/EES coupling ratio of 0.45 secondary to high EES in adaptation; hPDA group: time-trend analyses showed significantly lower EA (P<0.0001) and EES (P=0.006). Therefore, LV pumping was characterized by a lower EA/EES coupling ratio (P=0.088) throughout transition–adaptation.
Conclusions
In stable infants, facing high afterload, the immature LV, enhanced by the physiological PDA, increases its contractility. In hPDA, facing low afterload, the overloaded immature LV exhibits a consistently lower contractility.
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References
Azhibekov T, Soleymani S, Lee BH et al. Hemodynamic monitoring of the critically ill neonate: an eye on the future. Semin Fetal Neonatal Med 2015;20:246–254.
Engle WD . Blood pressure in the very low birth weight neonate. Early Hum Dev 2001;62:97–130.
Noori S, Seri I . Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev 2005;81:399–404.
El Hajjar M, Vaksmann G, Rakza T et al. Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed 2005;90:F419–F422.
Jain A, Shah PS . Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr 2015;169:863–872.
Evans N, Kluckow M . Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996;75:F183–F186.
Finnemore A, Groves A . Physiology of the fetal and transitional circulation. Semin Fetal Neonatal Med 2015;20:210–216.
Hamdani N, Herwig M, Linke WA . Tampering with springs: phosphorylation of titin affecting the mechanical function of cardiomyocytes. Biophys Rev 2017;9:225–237.
Walker JS, de Tombe PP . Titin and the developing heart. Circ Res 2004;94:860–862.
Prsa M, Sun L, van Amerom J et al. Reference ranges of blood flow in the major vessels of the normal human fetal circulation at term by phase-contrast magnetic resonance imaging. Circ Cardiovasc Imaging 2014;7:663–670.
Fernandez Pineda L, Tamariz-Martel Moreno A, Maitre Azcarate MJ et al. Contribution of Doppler atrioventricular flow waves to ventricular filling in the human fetus. Pediatr Cardiol 2000;21:422–428.
Bhorat I, Bagratee J, Reddy T . Gestational age-adjusted trends and reference intervals of the Modified Myocardial Performance Index (Mod-MPI) and its components, with its interpretation in the context of established cardiac physiological principles. Prenat Diagn 2014;34:1031–1036.
Tonino P, Kiss B, Strom J et al. The giant protein titin regulates the length of the striated muscle thick filament. Nat Commun 2017;8:1041–1049.
Sunagawa K, Maughan WL, Burkhoff D et al. Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol 1983;245:H773–H780.
Starling MR . Left ventricular–arterial coupling relations in the normal human heart. Am Heart J 1993;125:1659–1666.
Borlaug BA, Kass DA . Ventricular–vascular interaction in heart failure. Heart Fail Clin 2008;4:23–36.
Chantler PD, Lakatta EG . Arterial–ventricular coupling with aging and disease. Front Physiol 2012;3:90.
Chantler PD, Lakatta EG, Najjar SS . Arterial–ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985) 2008;105:1342–1351.
Tanoue Y, Sese A, Ueno Y et al. Bidirectional Glenn procedure improves the mechanical efficiency of a total cavopulmonary connection in high-risk fontan candidates. Circulation 2001;103:2176–2180.
Chowdhury SM, Butts RJ, Taylor CL et al. Validation of noninvasive measures of left ventricular mechanics in children: a simultaneous echocardiographic and conductance catheterization study. J Am Soc Echocardiogr 2016;29:640–647.
Chen CH, Fetics B, Nevo E et al. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 2001;38:2028–2034.
Kass DA . Age-related changes in venticular–arterial coupling: pathophysiologic implications. Heart Fail Rev 2002;7:51–62.
Taborsky HS . Arterial–Ventricular Coupling in Term Neonates and Infants up to 6 months, A Retrospective Data Analysis.. Vienna: Pediatric and Adolescence Medicine. Medical University of Vienna: Vienna, 2015: 69.
Engel J, Baumgartner S, Novak S et al. Ventriculo-arterial coupling in children with Still’s murmur. Physiol Rep 2014: 2.
de Boode WP, Singh Y, Gupta S et al. Recommendations for neonatologist performed echocardiography in Europe: Consensus Statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res 2016;80:465–471.
Teichholz LE, Kreulen T, Herman MV et al. Problems in echocardiographic volume determinations: echocardiographic–angiographic correlations in the presence of absence of asynergy. Am J Cardiol 1976;37:7–11.
Kelly RP, Ting CT, Yang TM et al. Effective arterial elastance as index of arterial vascular load in humans. Circulation 1992;86:513–521.
de Waal K, Phad N, Collins N et al. Cardiac remodeling in preterm infants with prolonged exposure to a patent ductus arteriosus. Congenit Heart Dis 2017;12:364–372.
Ky B, French B, May Khan A et al. Ventricular–arterial coupling, remodeling, and prognosis in chronic heart failure. J Am Coll Cardiol 2013;62:1165–1172.
Burkhoff D . Pressure–volume loops in clinical research: a contemporary view. J Am Coll Cardiol 2013;62:1173–1176.
Meyer S, Sander J, Graber S et al. Agreement of invasive versus non-invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age. J Paediatr Child Health 2010;46:249–254.
Nagasawa H, Kohno Y, Yamamoto Y et al. Methodologic comparison of left ventricular stroke volumes in the early neonatal period by echocardiography. Pediatr Cardiol 2014;35:1415–1420.
Burkhoff D, Sagawa K . Ventricular efficiency predicted by an analytical model. Am J Physiol 1986;250:R1021–R1027.
Khosroshahi HE, Ozkan EA, Kilic M . Arterial and left ventricular end-systolic elastance in normal children. Eur Rev Med Pharmacol Sci 2014;18:3260–3266.
Pladys P, Wodey E, Beuchee A et al. Left ventricle output and mean arterial blood pressure in preterm infants during the 1st day of life. Eur J Pediatr 1999;158:817–824.
Kluckow M, Evans N . Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000;82:F182–F187.
Antonini-Canterin F, Carerj S, Di Bello V et al. Arterial stiffness and ventricular stiffness: a couple of diseases or a coupling disease? A review from the cardiologist’s point of view. Eur J Echocardiogr 2009;10:36–43.
Schwarz CE, Preusche A, Baden W et al. Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study. BMC Pediatr 2016;16:18.
Noori S, McNamara P, Jain A et al. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation. J Perinatol 2015;35:123–127.
El-Khuffash A, Weisz DE, McNamara PJ . Reflections of the changes in patent ductus arteriosus management during the last 10 years. Arch Dis Child Fetal Neonatal Ed 2016;101:F474–F478.
Nagata H, Ihara K, Yamamura K et al. Left ventricular efficiency after ligation of patent ductus arteriosus for premature infants. J Thorac Cardiovasc Surg 2013;146:1353–1358.
Noori SSI . The very low birth weight neonate with a hemodynamically significant ductus arteriosus during the first postnatal week In: Polin R eds. Hemodynamics and Cardiology. Neonatology Questions and Controversies 2nd edn. New York: Columbia University Medical Center, 2008: 269–291.
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We thank Dave Hill for his valuable assistance in preparation of this manuscript.
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Baumgartner, S., Olischar, M., Wald, M. et al. Left ventricular pumping during the transition–adaptation sequence in preterm infants: impact of the patent ductus arteriosus. Pediatr Res 83, 1016–1023 (2018). https://doi.org/10.1038/pr.2018.22
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DOI: https://doi.org/10.1038/pr.2018.22
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